DESCRIPTION (APPLICANT'S ABSTRACT): The specific aim for this project is to determine if osteopathic manipulative treatment (OMT) is effective for persons with emphysema as a component of their chronic obstructive pulmonary disease (COPD). The major hypotheses to be tested during this research study are: An initial OMT session, designed to improve chest wall compliance and diaphragmatic function, will produce an immediate positive change in pulmonary function parameters and chest wall mobility. OMT sessions over a 12-week period of time will effect sustained improvement in pulmonary function parameters; chest wall mobility as measured by maximum chest wall expansion and reduction; and other clinical measures such as quality of life, exercise tolerance, and dyspnea. The sham treatment protocol developed will successfully blind subjects to their group assignment while providing an equivalent amount of contact time with the treating physicians relative to the treatment group. Subjects will be randomly assigned to either the OMT treatment or control group. In addition to conventional care for COPD, each group will receive its designated treatment protocol once a week for 13 weeks. The OMT treatment group will receive a standardized OMT protocol, and the control group will receive a standardized sham treatment protocol. Outcome measures will be obtained at baseline; immediately following the first treatment; at 4, 8, and 12 weeks after initiation of treatment; and 4 weeks after termination of the treatment. Outcome variables include pulmonary function tests; quality-of-life questionnaires (including emotional functioning, fatigue, and dyspnea); and measurements of exercise tolerance and chest wall mobility. This research project will be a significant step in expanding the understanding of the role of OMT in the treatment of chronic lung disease. It is expected to yield evidence that OMT is an important adjunctive modality that improves pulmonary function, increases exercise tolerance, relieves dyspnea, and improves quality of life in those with COPD, and that would have widespread clinical application plus significant economic benefits.